Art Work Provenance Disclosure Form
Artwork Information
Title of Artwork
Artist Name
Year of Creation
Medium
Dimensions
Ownership History
Previous Owners (List in chronological order, most recent first)
Acquisition Method
Provenance Documentation (describe any available documents or evidence)
Exhibition & Publication History
Exhibitions (list venue, dates, and curator if known)
Publications (list if included in catalogues, books, articles, etc.)
Additional Information
Additional Notes (e.g., restoration, damages, significant events)
Submitted by (Name)
Date